Sum Insured Rs.

Cataract

Health Insurance Policy

Unique Id: IRDA/NL-HLT/SHAI/P-H/V.II/172/14-15

Cerebrovascular Accident

Turning sixty is a major milestone for people, a time to start being more careful
about their health. It is a matter of concern that insurance policies are hardly
available to address this critical requirement.
STAR Health's Senior Citizens Red Carpet Health Insurance Policy is aimed
specifically at senior citizens. It provides cover to anyone from the age of 60 and
permits entry right up to the age of 75 with continuing cover thereafter till lifetime. It
is our way of caring for a generation that has done so much to build the country we
have today.

Cardiovascular Diseases

Special Features

Entry age from 60 to 75 years

Guaranteed Lifelong renewals

No pre-acceptance medical screening

In-patient Hospitalization Cover

Coverage for all Pre-existing diseases after 12 months from the date of
first commencement of policy

Cover for Medical Consultations as an Out Patient

Cancer

Treatment for
Breakage of Bones

Policy Benefits

Hospitalization Cover: Room, Boarding and Nursing expenses at 1% of

the sum insured subject to a maximum of Rs.6000/- per day.

ICU charges up to 2% of the sum Insured per day.

Surgeon's fees, Consultant's fees, Anesthetist's and Specialist's fees up

to 25% of the sum insured per hospitalization.

Anesthesia, Blood, Oxygen, Operation Theatre charges, Cost of

Pacemaker etc up to 50% of the sum insured per hospitalization.

Emergency ambulance charges for transporting the insured patient to the

hospital up to a sum of Rs.600/- per hospitalization and overall limit of
Rs.1200/- per policy period.

Treatment for specified diseaces subject to limits given below:

392.196 mm x 209.55 mm

Renal
Complications

All other major

surgeries

1,00,000
2,00,000
3,00,000
4,00,000
5,00,000
7,50,000
10,00,000
1,00,000
2,00,000
3,00,000
4,00,000
5,00,000
7,50,000
10,00,000
1,00,000
2,00,000
3,00,000
4,00,000
5,00,000
7,50,000
10,00,000
1,00,000
2,00,000
3,00,000
4,00,000
5,00,000
7,50,000
10,00,000
1,00,000
2,00,000
3,00,000
4,00,000
5,00,000
7,50,000
10,00,000
1,00,000
2,00,000
3,00,000
4,00,000
5,00,000
7,50,000
10,00,000
1,00,000
2,00,000
3,00,000
4,00,000
5,00,000
7,50,000
10,00,000

Limit of Companys
Liability Rs.

15,000
15,000
18,000
20,000
21,500
23,000
25,000
75,000
150,000
200,000
225,000
275,000
300,000
350,000
75,000
150,000
200,000
225,000
275,000
300,000
350,000
75,000
150,000
200,000
225,000
275,000
300,000
350,000
75,000
150,000
200,000
225,000
275,000
300,000
350,000
75,000
150,000
200,000
225,000
275,000
300,000
350,000
60,000
120,000
150,000
200,000
225,000
250,000
275,000

actual period of cover will start only from the date of payment of premium. In other words
no protection is available between the policy expiry date and the date of payment of
premium for renewal.
In the event of this policy being withdrawn / modified with revised terms and/or premium
with the prior approval of the Competent Authority, the insured will be intimated three
months in advance and accommodated in any other equivalent health insurance policy
offered by the Company, if requested for by the Insured Person, at the relevant point of
time.

Out Patient Medical Consultations

Cover for expenses incurred as an outpatient towards medical consultation in a network
hospital up to the limits mentioned in the table given below with a limits of Rs.200/- per
consultation. Payment under this benefit will not reduce the sum insured and is payable only
when the policy is in-force.

Sum Insured Rs.

1,00,000
2,00,000
3,00,000
4,00,000
5,00,000
7,50,000
10,00,000
Coverage for Pre-existing diseases :

Limit per policy period (Rs.)

NA

Enhancement of Sum Insured

The sum insured can be enhanced at the time of renewal of this policy subject to no claim
being lodged or paid under this policy, at the discretion of the Company. If enhancement of
sum insured is accepted by the Company, such enhancement is possible only for the
immediately next higher sum insured.
Where the sum insured is enhanced, the amount of such additional sum insured shall be
subject to the following terms:
Waiting period as under shall apply afresh from the date of such enhancement for the
increased sum insured, that is, the difference in sum insured between the previous sum
insured and the increased current sum insured.
I) First 30 days as under Exclusion No. 2
ii) 24 months with continuous coverage without break (with grace period) in
respect of diseases / treatments falling under Exclusion No.3
iii) 12 months of continuous coverage without break (with grace period) in respect
of Pre-Existing diseases as defined, under Exclusion No.1
The amount by which the sum insured is enhanced is subject to a waiting period of 12
months from the date of enhancement
I) in respect of diseases / conditions for which claim is paid or admitted as payable
in the previous policy period and / or
ii) for diseases / conditions diagnosed / treated, irrespective of whether any claim
is made or not in the previous policy period.
The above applies to each relevant insured person.

Exclusions
1. Pre Existing Diseases as defined in the policy until 12 consecutive months of
continuous coverage have elapsed, since inception of the first policy with any Indian
Insurer.
2. Any disease contracted by the insured person during the first 30 days from the
commencement date of this policy. This exclusion shall not apply in case of the
insured person having been covered under any health insurance policy (Individual or
Group Insurance policy) with any of the Indian Insurance companies for a continuous
period of preceding 12 months without a break.
3. During the first two years of continuous operation of this Senior Citizens Red Carpet
Health Insurance Policy any expenses on
a) Cataract, Glaucoma, Diseases of the anterior segment and posterior segment
of the eyes, All Diseases related to ENT, Diseases related to Thyroid, Prolapse
of intervertebral disc (other than caused by accident), Varicose veins and
Varicose ulcers, all diseases of Prostate, Stricture Urethra, all types of Hernia,
Varicocele, Hydrocele, Fistula / Fissure in ano, Hemorrhoids, Pilonidal Sinus
and Fistula, Rectal Prolapse, Stress Incontinence and Congenital Internal
disease / defect.
b) Gall bladder and Pancreatic diseases and all treatments (conservative,
interventional, laparoscopic and open) related to Hepato-pancreato-biliary
disease including Gall bladder and Pancreatic calculi. All types of management
for Kidney and Genito-urinary tract calculi.
c) All treatments (conservative, interventional, laparoscopic and open) related to
all diseases of Uterus, Fallopian tubes, Cervix and Ovaries, Dysfunctional
Uterine bleeding, Pelvic inflammatory diseases, Benign breast diseases.
d) Conservative, operative treatment and all types of intervention for diseases
related to Tendon, Ligament, Fascia, Bones and joint [other than caused by
accident]
e) Degenerative disc and Vertebral diseases including replacement of Bones and
Joints and Degenerative diseases of the Musculo-skeletal system

600
800
1000
1200
1400

All pre-existing diseases are covered after 12 months from the date of first commencement

of policy

Post Hospitalization:

A sum equivalent to 7% of the hospitalization expenses incurred comprising of Nursing

Charges, Surgeon / Consultant fees, Diagnostic charges, Medicines and drugs only
subject to a maximum of Rs.5,000/- per occurrence towards post hospitalization
medical expenses wherever recommended by the attending Medical Practitioner.

Pre-acceptance Medical Screening

No pre-acceptance Medical Screening irrespective of the age of the person and the sum
insured opted. However medical examination will be done for those who declare adverse
medical history. At present, 100% cost of such medical examination is borne by the company.
Under all circumstances, the proposer will be intimated in advance about the need to undergo
medical examination
Policy Premium (excluding service tax)

Sum Insured Rs.

100,000/200,000/300,000/400,000/500,000/750,000/10,00,000/-

Premium Rs.
4,450/8,456/12,900/15,501/18,000/
21,000/22,500/-

Renewal premium is subject to change with prior approval from the Regulator
A discount of 10% of the premium will be allowed if the proposer produces the following
documents to the satisfaction of the Company:a. Stress Thallium Report
b. BP Report
c. Sugar (blood & urine)
d. Blood urea & creatinine
The tests should have been taken not before 45 days from the date of the proposal
Tax Benefits
Payment of premium by any mode other than cash for this insurance is eligible for relief under
Section 80D of the Income Tax Act 1961
Co-payment :
50% of each and every claim relating to pre-existing diseases
30% of each and every claim for all other claims.
Renewal
The policy will be renewed except on grounds of misrepresentation / fraud committed. A
grace period of 30 days from the date of expiry of the policy is available for renewal. If renewal
is made within this 30 days period the continuity of benefits will be allowed. However the

5.
6.

7.
8.
9.

10.

11.

12.

13.

14.

15.
16.
17.
18.
19.
20.

21.

22. Any specific time-bound or life time exclusions applied, specified and accepted
by the insured.
23. Other expenses as detailed in the policy.(Please refer Policy for details)

The Company
Star Health and Allied Insurance Co. Ltd., is a joint venture between NRIs , Oman Insurance
Company UAE and an Indian Company being a special purpose vehicle formed by a group of
Indian Businessmen. M/s. ICICI Ventures, M/s. Sequoia Capital & M/s. TATA Capital
Growth Fund have also invested in the Company. It has a capital base of INR 651 crores.
As an exclusive Health Insurance Company and first of its kind in India, the Company is
committed in setting international benchmarks in service and personal caring.

Cancellation
The Company may cancel this policy on grounds of misrepresentation, fraud, moral
hazard, non disclosure of material fact as declared in the proposal form and/or claim
form at the time of claim or non-co-operation of the insured person, by sending the
Insured 30 days notice by registered letter at the Insured person's last known
address and no refund of premium will be made. The insured may at any time cancel
this policy and in such event the Company shall allow refund after retaining premium
at Company's short Period rate only (table given below) provided no claim has
occurred up to the date of cancellation

Star Advantages

PERIOD ON RISK

RATE OF PREMIUM TO BE RETAINED

Up to one-month

1/3rd of annual premium

Up to three months

of annual premium

Up to six months

3/4th of annual premium

Exceeding six months

Full annual premium

No Third Party Administrator, Direct in-house claim settlement.

Faster and hassle-free claim settlement.
Cashless hospitalization
Network of more than 6000 hospitals across India.
24 x 7 toll-free Helpline
Information on Health through Free Health Magazine.
Facility for maintaining personal health records in electronic format

Statutory Warning
Prohibition of Rebates: Section 41 of Insurance Act 1938 (Prohibition of rebates): No person
shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take
out or renew or continue an insurance in respect of any kind of risk relating to lives or property
in India, any rebate of the whole or part of the commission payable or any rebate of the
premium shown on the policy, nor shall any person taking out or renewing or continuing a
policy accept any rebate, except such rebate as may be allowed in accordance with the
published prospectuses or tables of the insurer:

Free Look Period:

A free look period of 15 days from the date of receipt of the policy is available to the
insured to review the terms and conditions of the policy. In case the insured is not
satisfied with the terms and conditions, the insured may seek cancellation of the
policy and in such an event the Company shall allow refund of premium paid after
adjusting the cost of pre-acceptance medical screening, if any, stamp duty charges
and proportionate risk premium for the period concerned provided no claim has been
made until such cancellation.

Any person making default in complying with the provisions of this section shall be liable for a
penalty which may extend to ten lakhs rupees.
The information provided in this brochure is only indicative.
Please refer to the policy document for complete information

Free look cancellation is not applicable at the time of renewal of the policy

Portability:
This policy is portable and is subject to Portability Regulations. If the insured is
desirous of porting this policy to another Insurer towards renewal, application in the
appropriate form should be made to the Company at least before 45 days from the
date when the renewal is due.

For more details on the risk factors, terms and conditions,

please read the sales brochure carefully before conducting sale

Where the outcome of acceptance of portability is still waiting from the new insurer on
the date of renewal, the existing policy will be extended on the request of the Insured
person, for a period not less than one month on pro rata premium. Such extended
cover will be cancelled only on the written request by the Insured Person, subject to a
minimum pro rata premium for one month. If the Insured Person requests in writing
to continue the policy with the Company without porting, it will be allowed by charging
the regular premium with the same terms as per the expiring policy. In case of a claim
made by the Insured person and admitted by the Company during such extension,
the policy will be extended for the remaining period by charging the regular premium.
Portability is not possible during the policy period. For details contact
portability@starhealth.in or call Telephone No +91-044-28288869

IRDAI OR ITS OFFICIALS DO NOT INVOLVE IN ACTIVITIES LIKE SALE OF ANY KIND OF
INSURANCE OR FINANCIAL PRODUCTS NOR INVEST PREMIUMS
IRDAI DOES NOT ANNOUNCE ANY BONUS. THOSE RECEIVING SUCH PHONE ARE
REQUESTED TO LODGE A POLICE COMPLAINT ALONG WITH DETAILS OF PHONE CALL
AND NUMBER
Buy Online: www.starhealth.in Avail Discount of 5%
Call Toll-free: 1800-425-2255 or 044-2828 8800
Fax Toll Free No: 1800-425-5522, sms STAR to 56677
CIN : U66010TN2005PLC056649 IRDAI Regn. No: 129

SENIOR CITIZENS RED CARPET HEALTH INSURANCE POLICY

Claims Procedure

Call the 24 hour help-line for assistance - 1800 425 2255

Inform the ID number for easy reference

In case of planned hospitalization please inform 24 hours prior to admission in

the hospital

In case of emergency hospitalization information to be given within 24 hours

after hospitalization

In non-network hospitals payment must be made up-front and then

reimbursement will be effected on submission of documents

Unique Id: IRDA/NL-HLT/SHAI/P-H/V.II/172/14-15

SPC-01-06-15-50K-PO:

4.

f) Subcutaneous benign lumps, Sebaceous cyst, Dermoid cyst, Lipoma,

Neurofibroma, Fibro adenoma, Ganglion and similar pathology
g) Any transplant and related surgery
This waiting period shall not however apply in the case of the Insured person/s having
been covered under any Individual health insurance scheme with any of the Indian
Insurer for a continuous period of preceding 24 months without any break.
Circumcision (except where medically necessary), Inoculation or Vaccination
(except for postbite treatment and for medical treatment other than for prevention of
diseases)
Dental treatment (unless necessitated due to accidental injuries and requiring
hospitalization), any form of cosmetic surgery and / or implants.
Convalescence, General debility, Run-down condition or rest cure, Nutritional
deficiency states, Psychiatric, Mental and behavioural disorders, Congenital external
disease or defects or anomalies, Venereal disease and Sexually Transmitted
Diseases, intentional self injury and use of intoxicating drugs / alcohol, smoking and
tobacco chewing.
Injury/disease directly or indirectly caused by or arising from or attributable to war,
invasion, act of foreign enemy, warlike operations (whether war be declared or not).
Injury or disease directly or indirectly caused by or contributed to by nuclear
weapons/materials
Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or
complications of any of these (other than ectopic Pregnancy), family planning
treatment and all types of treatment for infertility and its complications thereof.
Expenses incurred on weight control services including surgical procedures for
treatment of obesity, medical treatment for weight control, treatment for metabolic,
genetic and endocrine disorders.
All expenses arising out of any condition directly or indirectly caused due to or
associated with human T-cell Lymph tropic Virus type III (HTLV-III) or
Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or Variations
Deficiency Syndrome or any Syndrome or condition of a similar kind commonly
referred to as AIDS.
Expenses incurred on High Intensity Focused Ultra Sound, Uterine fibroid
embolisation, Balloon Sinoplasty, Enhanced External Counter Pulsation Therapy
and related therapies, Chelation therapy, Deep Brain Stimulation, Hyperbaric
Oxygen Therapy, Rotational Field Quantum Magnetic Resonance Therapy,
Photodynamic therapy and such other therapies similar to those mentioned herein
under exclusion No.12.
Expenses incurred on Lasik Laser or Refractive Error Correction and its
complications, all treatment for disorders of eye requiring intra-vitreal injections and
related procedures.
Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-ray or
laboratory examinations not consistent with or incidental to the diagnosis and
treatment of the positive existence or presence of any ailment, sickness or injury, for
which confinement is required at hospital/nursing home.
Expenses on vitamins and tonics unless forming part of treatment for injury or
disease as certified by the attending Physician.
Naturopathy Treatment, Unconventional, Untested, Unproven, Experimental
therapies.
Stem cell Therapy and related transplantation, Chondrocyte Implantation,
Immunotherapy, Oral Chemo Therapy.
Hospital registration charges, admission charges, record charges, telephone
charges and such other charges.
Expenses incurred for treatment of diseases/illness/accidental injuries by systems of
medicines other than Allopathy.
Change of sex or cosmetic or aesthetic treatment of any description, plastic surgery
(other than as necessitated due to an accident or as a part of any illness), all
treatment for erectile dysfunctions.
Cost of spectacles and contact lens, hearing aids, Cochlear implants, walkers and
crutches, wheel chairs, CPAP, BIPAP, Continuous Ambulatory Peritoneal Dialysis,
infusion pump and such other similar aids.